SLH Foundation Parent/Guardian Release

The Sandra L. Heyman (SLH) Foundation

Fellowship Application Parent or Guardian Release Acknowledgement and Approval of Applicant’s Participation - Due December 3, 2024
Fellowship Parent/Guardian Release
Parent or Guardian Release Acknowledgement and Approval of Applicant’s Participation

A student under your care has applied for a Fellowship with The Sandra L. Heyman Foundation. For more information about the Fellowship program, visit: https://www.theslhfoundation.org/. Decisions about the selection of Fellows will be made by the Foundation in December. All applicants will be notified about decisions via email. To complete their submission this release must be signed by a parent or guardian.

If you have questions or wish to receive a copy of the application submitted, please contact us at: apply@theslhfoundation.org.

Thank you!
I. Parent/Guardian Contact Information
Parent/Guardian Name*

First NameLast Name
Phone #*
Phone Type*

MobileHomeWork
Email *
Student/Applicant Name*

First NameLast Name
II. Parent/Guardian E-Signature
Permission to Use Fellows’ Images:
From time-to-time, Fellows may be photographed and/or videotaped for promotional or
informational purposes. Any such photographs, films, recordings, or electronic images shall
be the sole property of The Sandra L. Heyman Foundation. From time to time, The Sandra L.
Heyman Foundation will issue brief updates about the Fellowship program’s activities via
its website, flyers, and social media postings.
Please check one of the options below:*

I agree with the above terms and give permission for the Foundation to use photos or video of Applicant while engaged in Fellowship program activities for information and promotional purposes.I do not wish the Foundation to use photos or video of Applicant while engaged in Fellowship program activities for any purposes.
Limitation of Liability Release

As consideration for being permitted by the SLH Foundation to participate in the fellowship activities, I agree that the SLH Foundation and its Board of Directors, officers, agents, guest speakers, mentors, and representatives (“Foundation Releasees”) assume no responsibility for any injury or damage arising out of, or in part cause by, Applicant’s participation in the Fellowship, either while in transit to or from or at the Fellowship program locations.

I further agree that I (parent/guardian), the Applicant, and legal representatives hereby voluntarily indemnify, release from liability, agree to defend and hold harmless the Foundation Releasees for any loss, liability, damage or cost, including court costs and attorneys’ fees they may incur due to Applicant’s participation in the Fellowship, whether caused by negligence of the Foundation Releasees or otherwise.

I further voluntarily indemnify, release from liability, agree to defend and hold harmless the Foundation Releasees resulting from any accident, injury, illness, death, loss, theft, damage to person or property, or other consequences arising or resulting directly or indirectly from Applicant’s participation in the Fellowship, including while traveling to or from Fellowship locations.

My signature below confirms that I am the parent or guardian of the Applicant listed above and approve of them applying for and, if accepted, participating in The SLH Foundation STEM Fellowship program. My signature also acknowledges and accepts the Limitation of Liability Release as set forth above.
Signature*

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The Sandra L. Heyman (SLH) Foundation

Fellowship Parent/Guardian Release

I. Parent/Guardian Contact Information

II. Parent/Guardian E-Signature